腹腔镜辅助远端胃癌根治术中十二指肠优先离断对胃癌患者应激反应、炎性因子和生活质量的影响

Effect of Duodenal Prior Disconnection in Laparoscopic Assisted Distal Gastrectomy on Stress Response, Inflammatory Factors and Quality of Life in Patients with Gastric Cancer

目的:探讨腹腔镜辅助远端胃癌根治术中十二指肠优先离断对胃癌患者应激反应、炎性因子和生活质量的影响。方法:回顾性选取2018年3月~2020年12月期间河北省邯郸市中心医院收治的行腹腔镜辅助远端胃癌根治术的胃癌患者93例,根据患者手术方式的不同将患者分为对照组45例和研究组48例,对照组给予左侧后入路的腹腔镜辅助远端胃癌根治术,研究组给予十二指肠优先离断腹腔镜辅助远端胃癌根治术,比较两组围术期指标、应激反应、炎性因子、生活质量以及术后并发症情况。结果:两组清除淋巴结数量对比差异无统计学意义(P>0.05),研究组手术时间、胃肠道功能恢复时间、住院时间短于对照组,术中出血量少于对照组(P<0.05)。研究组术后3 d、术后5 d血糖、皮质醇、肾上腺素低于对照组(P<0.05)。研究组术后3 d、术后5 d白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)低于对照组(P<0.05)。研究组术后1个月主观症状、生理功能状态、社会活动功能、心理情绪状态评分高于对照组(P<0.05)。两组术后并发症发生率对比无差异(P>0.05)。结论:与左侧后入路的腹腔镜辅助远端胃癌根治术相比,十二指肠优先离断可简化腹腔镜辅助远端胃癌根治术的手术步骤,减少胃癌患者术后应激反应和炎性反应,可有效促进患者术后恢复。

Objective: To investigate the effect of duodenal prior disconnection in laparoscopic assisted distal gastrectomy on stress response, inflammatory factors and quality of life in patients with gastric cancer. Methods: 93 cases of patients with gastric cancer undergoing laparoscopic assisted distal gastrectomy in Handan Central Hospital of Hebei Province from March 2018 to December 2020 were selected, and they were divided into control group with 45 cases and study group with 48 cases according to different operation methods. The control group was given laparoscopic assisted distal gastrectomy via left posterior approach, and the study group was given duodenal prior disconnection laparoscopic assisted distal gastrectom. Perioperative indicators, stress response, inflammatory factors, quality of life and postoperative complications in two groups were compared. Results: There was no significant difference in the number of lymph nodes removed between the two groups(P>0.05). The operation time, recovery time of gastrointestinal function and hospitalization time of the study group were shorter than those of the control group and the intraoperative blood loss of the study group was less than that of the control group(P<0.05). The blood glucose, cortisol and epinephrine of the study group were lower than those of the control group at 3 d and 5 d after operation(P<0.05). The levels of interleukin-6(IL-6), C-reactive protein(CRP) and tumor necrosis factor-α(TNF-α)of the study group were lower than those of the control group at 3 d and 5 d after operation(P<0.05). The scores of subjective symptoms,physiological function, social activity function and psychological emotion state of the study group were higher than those of the control group at 1 month after operation(P<0.05). There was no significant difference in the incidence rate of postoperative complications between the two groups(P>0.05). Conclusion: Compared with laparoscopic assisted distal gastrectomy via left posterior approach, duodenal priority can simplify the operation steps of laparoscopic assisted distal gastrectomy, reduce the stress reaction and inflammatory reaction of patients with gastric cancer, and effectively promote the recovery of patients after operation.